May 2021

Medicaid

Monthly News for Blue Cross and Blue Shield of Texas (BCBSTX) Medicaid (STAR), STAR Kids and CHIP Providers

Read this month’s Medicaid news to learn about:

• COVID-19 News and Updates
• COVID-19 and Childhood Obesity Complexities
• Texas Medicaid and CHIP Guidance on Asthma Education Coverage
• Tips for Preventing Youth Suicide
• Updated Process for Urine Drug Testing (UDT) Claims for Texas Medicaid Members
• Update to Prior Authorization Codes for Medicaid Members

COVID-19 Provider Preparedness Updates

As the COVID-19 crisis evolves, we’re continuing to make updates on our COVID-19 Preparedness and our COVID-19 Related News pages. Be sure to check these pages frequently for updates including COVID-19: Texas Provider FAQs and COVID-19: FAQs for Medicare Providers.

Provider Satisfaction Survey 2021

A strong working relationship with providers is important to us. As such, each year we survey a random sample of providers. If you are selected, you will receive the survey between May and August from SPH Analytics via email, mail and phone.

Access to Resources to Support Quality Care

Now’s the time to encourage your patients to catch up on their health. Their wellness can’t wait – even during the COVID-19 pandemic. To support quality care, we’re providing information to providers and members to encourage discussions on health topics.

Professional Provider Fee Schedule via Availity^®

Soon, some participating professional providers will have access to a new online Fee Schedule Viewer tool via the Availity Provider Portal. Attend upcoming training sessions to learn how to submit requests using the tool.

Reminder: PEAQ Program

Soon, PEAQ reports will be available to scored physicians via Availity. Be sure to sign up for Availity so you will be ready to review the reports.

New Applied Behavior Analysis (ABA) Service Request Forms

As of March 2021, we’ve updated our ABA service request forms to streamline the data required for review. Learn how to request services.

Major Depressive Disorder

Major Depressive Disorder needs to be accurately and completely documented and coded to help our members access the resources they need. Review ICD-10 documentation tips and best practices.

CERiS to Review Complex Claims

Beginning July 2021, EquiClaim will no longer review complex claims from providers and facilities on behalf of BCBSTX. CERiS, however, will conduct these reviews and if a claim is reimbursed incorrectly, they will tell you how to repay the funds or appeal the decision.

Enrollee Notification Form Required for Out-of-Network Care for Blue Choice PPO^SM and Blue Advantage HMO^SM (for Blue Advantage Plus)

It is essential that Blue Choice PPO and Blue Advantage Plus enrollees fully understand the financial impact of an out-of-network referral to a health care provider who does not participate in their BCBSTX provider network.

Clinical Payment and Coding Policy Updates

The Clinical Payment and Coding Policies describe payment rules and methodologies for CPT^®, HCPCS and ICD-10 coding for claims submitted as covered services. This information is a resource for our payment policies; it is not intended to address all reimbursement-related issues. We regularly add and modify clinical payment and coding policy positions as part of our ongoing policy review process. The following have been recently added or updated:

• Preventive Services Policy – Effective 4/1/2021
• Non-Reimbursable Experimental, Investigational and/or Unproven Services (EIU) – Effective 05/15/2021 – Updated 03/26/2021 for code C9771
• Medical Record Documentation Guideline  – Effective 07/12/2021
• Psychological and Neuropsychological Testing; – Effective 07/12/2021
• Surgical and Non-Surgical Services Guide – Effective 07/12/2021
• Modifier Reference Guideline – Effective 07/15/2021

Reminder:

• Multiple Procedure Payment Reduction Claims Review

Speaking Out About the ‘Silent Killer’

High blood pressure, or hypertension, is known as a “silent killer” because it usually has no warning signs. Review best practices and ways to close gaps in care.

Blue Cross Medicare Advantage (PPO)^SM Network Sharing

All Blue Cross and Blue Shield Medicare Advantage^SM (BCBS MA PPO) plans participate in reciprocal network sharing. This network sharing allows all BCBS MA PPO members to obtain in-network benefits when traveling or living in the service area of any other BCBS MA PPO plan if the member sees a contracted BCBS MA PPO provider. Access detailed information on BCBS MA PPO network sharing. If you have any questions regarding the BCBS MA PPO program or products, contact Blue Cross Medicare Advantage (PPO) Customer Service at 1-877-774-8592.

Preventive Services Reminder: Zero Copay for Blue Cross Medicare Advantage

As a reminder, there are no copays for preventive services for Blue Cross Medicare Advantage (PPO) or Blue Cross Medicare Advantage (HMO)^SM members. Blue Cross Medicare Advantage covers a full range of preventive services to keep patients healthy, find problems early and determine when treatment is most effective.

Update to Prior Authorization Codes for Medicaid and Medicare Members

We are changing prior authorization requirements for Medicare and Medicaid members to reflect new, replaced or removed codes due to updates from our Utilization Management team or the American Medical Association. A summary of changes is included.

Reminder:

• Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Annual Health Assessment Incentive

Update to Prior Authorization Codes for Commercial Members

We will be updating our lists of procedure codes that require prior authorization to reflect new, replaced or removed codes.

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